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Suicide is a leading cause of death among children in the United States; firearms cause 37% of these deaths. Research is needed to better understand firearm accessibility among youth at risk for suicide. We reviewed data from the National Fatality Review Case Reporting System (NFR-CRS). Firearm suicide deaths of children ages 10-18 occurring 2004 through 2015 with completed suicide-specific section were included. Children who had talked about, threatened or attempted suicide were identified as 'Greater Risk' (GR). Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated. Of the 2106 firearm suicide deaths, 1388 (66%) had a completed NFR-CRS suicide section. Of these, 36% (494/1388) met the criteria for GR. Firearms were less likely to be stored in a locked location for GR children [adjusted OR 0.62, (95%CI 0.49-0.98)]. Strategies to limit firearm access, particularly for GR youth, should be a focus of suicide prevention efforts., Author(s): Patricia G. Schnitzer [sup.1] , Heather K. Dykstra [sup.1] , Theodore E. Trigylidas [sup.2] , Richard Lichenstein [sup.3] Author Affiliations: (Aff1) 0000 0001 0028 3686, grid.415507.2, National Center for [...]

Objectives. We sought to describe approaches to surveillance of fatal child maltreatment and to identify options for improving case ascertainment. Methods. Three states--California, Michigan, and Rhode Island--used multiple data sources for surveillance. Potential cases were identified, operational definitions were applied, and the number of maltreatment deaths was determined. Results. These programs identified 258 maltreatment deaths in California, 192 in Michigan, and 60 in Rhode Island. Corresponding maltreatment fatality rates ranged from 2.5 per 100000 population in Michigan to 8.8 in Rhode Island. Most deaths were identified by child death review teams in Rhode Island (98%), Uniform Crime Reports in California (56%), and child welfare agency data in Michigan (44%). Compared with the total number of cases identified, child welfare agency (the official source for maltreatment reports) and death certificate data underascertain child maltreatment deaths by 55% to 76% and 80% to 90%, respectively. In all 3 states, more than 90% of cases ascertained could be identified by combining 2 data sources. Conclusions. No single data source was adequate for thorough surveillance of fatal child maltreatment, but combining just 2 sources substantially increased case ascertainment. The child death review team process may be the most promising surveillance approach. (Am J Public Health. 2008;98:296-303. doi:10.2105/AJPH.2006.087783)

Objectives. Studies from other countries have identified fishing as a hazardous industry, but little is known about occupational injury mortality related to fishing in the United States. Alaska was chosen for this study because approximately 45 000 people annually participate in Alaska's fishing industry and fishing is thought to be a major contributor to occupational injury mortality in the state. Methods. Work-related injury deaths in Alaska's fishing industry were identified by means of death certificates and US Coast Guard mortality data. Fatality rates were calculated by using average annual fishing industry employment estimates. Results. The 5-year average annual fishing-related fatality rate was 414.6 per 100 000 fishermen. The majority of the decedents were Caucasian men who drowned while fishing. Conclusions. This study emphasizes that fishing is a dangerous industry in Alaska and demonstrates the benefit of using multiple data sources to identify fishing-related deaths in the state. (Am J Public Health. 1993;83:685-688), The fatality rate in Alaska's fishing industry is five to eight times greater than that found in other high-risk industries in the state. Review of death certificates indicated a five-year average of 414.6 deaths per 100,0000 fishermen. This fatality rate is considerably higher than Alaska's overall occupational death rate of 34.2 per 100,000 and than the average combined rate for all 50 states, which is 7.8 deaths per 100,000 workers. Deaths related to the fishing industry are often underestimated for a variety of reasons including the seasonal nature of the work and the exclusion of presumptive death certificates in mortality statistics. Presumptive certificates are issued by judges when no bodies are found. They often fail to indicate a cause of death. More accurate statistics will need to include data from several sources in addition to standard death certificates.

Injuries are the leading cause of death in children and teenagers in the United States. The leading causes of unintentional injury vary by age and include drowning, poisoning, suffocation, fires, burns, falls, and motor vehicle, bicycle, and pedestrian-related crashes. Most injuries are preventable by modifying the child's environment (e.g., use of stair gates) and having parents engage in safety practices (e.g., keeping matches or lighters out of reach of children). Effective injury prevention methods include the use of childproof caps on medications and household poisons, age-appropriate restraints in motor vehicles (i.e., car seats, booster seats, seat belts), bicycle helmets, and a four-sided fence with a locked gate around residential swimming pools. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Occupational Injury Deaths in Alaska's Fishing Industry, 1980 Through 1988," by P. G. Schnitzer and D. D. Landen, which appeared in the 1993 issue.